NPIMap

Organization Active NPI

Sac & Fox of the Miss in Iowa

  • Primary Care Clinic/Center
  • Tama, IA
National Provider Identifier
1962618355
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SAC & FOX OF THE MISS IN IOWA
Practice address
1646 305TH Street
Ste a
Tama, IA 52339-9634
Phone
(641) 484-4094
Fax
(641) 484-2432
NPI assigned
May 15, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mirza Gonzales
Title
Director Administrative Services
Phone
(641) 484-4094

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20050511000970 IA Part B Supplier - Clinic/Group Practice 6507806239 Receives reassigned benefits from 13 practitioners
Practice locations: Tama, IA
O20191021000786 IA DME Supplier - Physician - Osteopathic Manipulative Medicine 6507806239 Practice locations: Tama, IA

National Provider Directory

National Provider Directory
Tax ID family
Sac Fox Tribe of the Miss in Iowa (3 organizations share this tax ID)

Locations

307 Meskwaki Rd
Tama, IA 52339
Phone (641) 484-4094

1646 305th St
Ste A
Tama, IA 52339
Phone (641) 484-4094

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

NPPES NPI Registry

Primary practice location

1646 305TH Street
Ste a
Tama, IA 52339-9634

Mailing address

1646 305TH Street
Tama, IA 52339-9634
Phone (641) 484-4094

Other names 1

NPPES NPI Registry
  • Sac & Fox of The Miss In Iowa Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 15, 2014.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1962618355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1646 305TH STREET",
            "city": "TAMA",
            "state": "IA",
            "postal_code": "523399634",
            "telephone_number": "641-484-4094",
            "fax_number": "641-484-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1646 305TH STREET",
            "address_2": "STE A",
            "city": "TAMA",
            "state": "IA",
            "postal_code": "523399634",
            "telephone_number": "641-484-4094",
            "fax_number": "641-484-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAC & FOX OF THE MISS IN IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "MIRZA",
        "authorized_official_title_or_position": "DIRECTOR ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "641-484-4094"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sac & Fox of The Miss In Iowa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tama, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.